Intrauterine insemination (IUI)
Once known as artificial insemination, intrauterine insemination (IUI) is the process by which sperm is deposited in a woman’s uterus through artificial means. For many couples, this is a less invasive and more affordable alternative to IVF.
Placing the Sperm

The IUI process occurs when a very thin flexible catheter is inserted through the cervix and washed sperm is injected into the uterus.

Most women consider IUI to be fairly painless, along the same lines as having a pap smear. There can be some cramping afterward, but often what is felt is ovulation-related rather than from the IUI. The catheter often isn’t felt because the cervix is already slightly open for ovulation.

You will be given instructions on how long beforehand and afterwards to abstain from intercourse, and any resting periods after the IUI.

When Should it be Done?

Ideally an IUI should be performed within 6 hours either side of ovulation (for male factor infertility, some doctors believe after ovulation is better) with the sperm waiting for the egg. When timing is based on an hCG injection, the IUIs are usually done between 24 and 48 hours later. Typical timing would be to have a single IUI at about 36 hours post-hCG. If two IUIs are scheduled, they are usually spaced at least 12 hours apart between 24 and 48 hours after the hCG.

If no use of drugs is done, then doctors will base timing of IUI on a natural LH surge. In that case, a single IUI at 36 hours is the norm, but doing them at 24 hours is also quite common.

Success

The success rates are reported to be just under 6% and as high as 26% per cycle. The low statistics are with one follicle, while multiple follicles resulted in as high 26% success.

SPERM ANALYSIS

A semen analysis measures the quantity and quality of both the liquid portion, called semen, and the microscopic, moving cells, called sperm.
Semen is the turbid, whitish substance that is released from the penis during ejaculation. Sperm are the cells in semen with a head and a tail that enables them to travel to the egg. A sperm contains one copy of each chromosome (all of the male’s genes) and fuses with the female’s egg, resulting in fertilization.

Typical semen analysis measures:

1. the volume of semen,
2. sperm concentration,
3. total number of sperm,
4. sperm motility (percent able to move as well as how vigorously and straight the sperm move),
5. the number of normal and not normal (defective) sperm,
6. agglutination and liquefaction,
7. the number of immature sperm, and
8. the number of white blood cells (cells that indicate infection).

Additional tests may be performed if semen is abnormal, such as a test for sperm antibodies. If assisted reproductive technology is contemplated (for example, in vitro fertilization), sperm function tests may also be performed.

How is the sample collected for testing?

We prefer samples to be collected on-site as the semen needs to be examined within ONE HOUR after ejaculation. Semen is collected in a private room in Clinic. The man masturbates and collects the semen in a jar.

What does the test result mean?

The typical volume of semen collected is around a teaspoonful (2-6 milliliters) of fluid. Less semen would indicate fewer sperm, which would affect fertility. More semen indicates too much fluid, which would dilute the sperm, also impeding fertility.

Sperm concentration (also called sperm density) is measured in millions of sperm per milliliter of semen. Normal is greater than or equal to 20 million per milliliter (and more than 80 million sperm in one ejaculation). The fewer sperm a sample has, the less chance a man has of getting a woman pregnant. A man who has just had a vasectomy would want to have no sperm in his sample.

Motility is the percentage of moving sperm in a sample. The more slowly moving or immobile sperm in a sample, the less likely it is that a man could get a woman pregnant. The progression of the sperm is rated on a basis from zero (no motion) to 3 or higher for sperm that move in a straight line with good speed. If less than half of the sperm are motile, a stain is used to identify the percentage of dead sperm. This is called a sperm viability test.

Morphology analysis is the study of the size, shape, and appearance of the sperm cells. The analysis evaluates the structure of 200 sperm, and any defects are noted. The more abnormal sperm that are present, the lower the likelihood of fertility.

Is there anything else I should know?

To give sperm a chance to replenish, a man should abstain from ejaculating for two to four days before the sample is collected. The most detailed instructions will be provided after making an appointment for analysis.

Sperm are very temperature-sensitive. If collection is done at home, the sample should be kept at room temperature (70°F/21°C) at all times.
Several factors can affect the sperm count and other semen analysis values. A man may have a lower sperm count if he has physical damage to the testicles, has gone through radiation treatment of his testicles, or has had exposure to certain drugs (such as azathioprine or cimetidine). A man with a higher level of estrogens may have lower sperm counts.

Some of the common causes of male infertility are extremely high fever, failure of the testicles, obstruction of the tubes that carry semen to the penis, and a less than normal amount of sperm in the sample (oligospermia).

SPERM STORAGE

Any man can have his semen frozen and stored for later use.
The reasons for storage (or deposit) can be many, but a common feature of all cases is the future possibility of becoming a father.
Semen Deposit can be an option if you:

1. consider to be vasectomized (sterilized),
2. are working with dangerous chemical reagents etc. and are concerned that you might damage your sperm,
3. have cancer or some other disease where medical treatment (for instance chemotherapy or radiation) might sterilize you,
4. are under treatment for infertility, but cannot be present at the planned time for treatment (ovulation), or if you know that you might find it difficult to ejaculate on command at the time of treatment,
5. merely wish to secure your reproductive capacity.

EMBRYO FREEZING AND STORAGE

Embryo freezing (cryopreservation) is a technical procedure by means of which embryos are stored for long periods of time at a low temperature (-196C). The period from fertilization to day 14 is called “embryonic” and therefore the term embryo is used. Embryos can be frozen between the single cell stage and the blastocyst (up to 200 cells) stage of development. Water in the embryos is replaced with a chemical solution (cryoprotectant) that functions like antifreeze. If a cryoprotectant is not used, as the temperature decreases, water in the embryos freezes and forms ice crystals. These crystals destroy embryos. When embryos are thawed, the cryoprotectant is removed and replaced with water.

Typically, either two or three embryos are transferred to the uterus during an IVF cycle. However, some cycles will produce more than two or three embryos. Embryo freezing provides a way that these extra or “spare” embryos can be stored and returned during a later cycle. Embryo freezing, therefore, increases the options available to IVF couples.

Prior to freezing, the quality of the embryos is evaluated based on appearance to determine their suitability for freezing. Studies suggest that embryos that show physical blemishes of 25% or less are more likely to survive the freezing procedure. Consequently, even when there are spare embryos, they may not be suitable for freezing because of their poor quality.

HOW WILL FROZEN EMBRYOS BE RETURNED?

Frozen embryos usually are returned during a natural menstrual cycle (no medications). In some cycles medications may be given to prepare the lining of the uterus for implantation. At the appropriate time, the frozen embryos are thawed. The timing of thawing and transfer is determined on an individual basis.

What is IVF?

The initials IVF stand for in vitro fertilisation, with “in vitro” being Latin for “in glass” – a reference to the glass test tubes used in the laboratory. This is where the phrase ‘test tube baby’, often used in the media, stems from.

IVF treatment – in summary – involves Ovulatin Induction (administration of fertility drugs to stimulate your ovaries to produce a number of eggs) and then, using a minor surgical procedure, Egg Retrieval (we collect your eggs) and place them in a culture dish (rather than a test tube) with prepared sperm, for fertilisation on the culture dish.

One or two of the resulting embryos can then be transferred to the womb/uterus, and any suitable embryos not used in this cycle can be frozen for you to use in future – Embryo Cryopreservation.

Who needs IVF?

IVF treatment may be appropriate in cases of male factor infertility or unexplained infertility, if you have blocked fallopian tubes, or have experienced a lack of success with other fertility treatments such as ovulation induction or IUI (Intrauterine Insemination).

Below are some factors for using IVF:

1. Tubal problems can mean a woman’s fallopian tubes are blocked or damaged, which can make it difficult for the egg to be fertilized or for an embryo to travel to the uterus.
2. Male factor can include a low sperm count, problems with sperm function or motility which can inhibit sperm from fertilizing an egg on its own.
3. Severe Endometriosis affecting both fertilization of the egg and implantation of the embryo in the uterus.
4. Ovarian issues which prevent the release or production of eggs.
5. Abnormal uterus shape, fibroid tumors, or exposure to diethylstilbestrol (DES) as a fetus.
6. Unexplained infertility

What happens at the Clinic?

Following an initial consultation with one of our fertility specialists, you’ll start your agreed treatment plan. This will involve taking IVF drugs for several weeks to stimulate egg production and prepare your womb to receive the embryos.

You’ll need to visit the Clinic for scans and blood tests during this time, and we’ll monitor you closely to assess your response to the medication and decide when to proceed to egg collection.

Since your treatment plan is individual, the drug dosage and number of visits will depend on how your body responds.

Most patients can expect to attend the Clinic for up to four monitoring visits, and we’ll review your progress each time. We’ll also discuss, in detail, any potential modifications to your treatment.

Egg collection is a minor surgical procedure, carried out by one of our fertility specialists. It involves an ultrasound guided vaginal egg collection. We immediately pass the collected eggs to our on-site embryology laboratories, which are environmentally controlled.

Following the fertilisation of your eggs with sperm, we can transfer one or two of the resulting embryos to your womb through a narrow catheter that’s passed through your cervix. 18 days after egg collection, you’ll be able to do a pregnancy test. If this is positive, you should attend the clinic about 20 days later for a pregnancy scan.

Here’s an example IVF journey, giving you an indication of the stages in the process and likely number of visits to the Clinic.

What is ICSI?

ICSI stands for Intracytoplasmic Sperm Injection. The procedure follows on from egg collection and involves injecting a single sperm into the centre of each mature egg, to help fertilisation to occur.

One or two of the resulting embryos can be transferred to your womb in the same way as in a conventional IVF cycle. Any additional embryos not transferred in this cycle can be frozen for your future use.

Who needs ICSI?

We use ICSI in conjunction with an IVF cycle when we believe that fertilisation is unlikely to occur using only conventional IVF.

Most typically, ICSI is appropriate when there is a male factor to your infertility. We might recommend ICSI when:

1. The number of sperm is low
2. There’s poor sperm motility (movement)
3. There’s a high number of abnormal sperm
4. The sperm has been collected surgically
5. There are high levels of antibodies in the semen
6. There have been previous unexplained failures to achieve fertilisation in conventional IVF, or when very few eggs have fertilised following IVF
7. Sperm function tests have shown that the sperm would be unlikely to achieve fertilisation, or embryo quality and implantation may be compromised
8. Donated gametes are being used

What happens at the Clinic?

Your treatment cycle is exactly the same, both before and after egg collection, as for conventional IVF. The only difference is that our embryologists use micro-manipulation techniques in the laboratory to fertilise your eggs, instead of placing sperm and eggs together in a tissue culture dish.

What is blastocyst culture?

This term describes the process when the embryos grow for longer in the laboratory, and undergo critical developmental changes before being returned to the womb.

This period of extended culture helps our experts select the most competent embryo(s) for transfer to your womb, and can help to indicate which embryos have the best growth potential. Therefore, blastocyst culture maximises the chance of you achieving a viable pregnancy.

By the time an embryo has reached the blastocyst stage, it’s already undergone several cell divisions and achieved its first cell differentiation into two distinct cell types.

Although this period of extended culture doesn’t necessarily improve the quality of the embryos, or guarantee that they reach the blastocyst stage, we have impressive success rates for this treatment.

Who needs blastocyst culture?

You’re likely to benefit from this treatment if you have a large number of embryos. That’s because not all embryos have the ability to form a blastocyst, and the number of embryos progressing each day may decrease.

Blastocyst culture allows the most advanced/competent embryo(s) to be selected for transfer on the fifth day following egg collection. Our results indicate that with five or more embryos on day one after egg collection, there’s an improved pregnancy rate using extended culture compared to using day two or three transfers.

What happens at the Clinic?

Your treatment cycle is exactly the same as for IVF, except that your embryos will be cultured for longer in the embryology laboratory. This means that the day of your embryo transfer will be five days after egg collection.

This process enhances our embryologists’ ability to select the embryo(s) most likely to result in pregnancy.

The aim of the procedure is to ease embryo escapement from the egg shell (zona pellucida) and therefore facilitate embryo implantation providing higher chance for pregnancy.

On the day of embryo replacement the embryologist makes small hole in the egg shell.

The method can be used before fresh and frozen embryo replacement.

This method is often used in case of prior failed IVF cycles, female age over 38, and with abnormally thick egg shells, that may be discovered during IVF/ICSI treatment. Some studies indicate that this method also increases success rate in frozen embryo transfers.

The treatment is used in cases; when ovaries cannot produce own eggs or egg quality is too low to get successful fertilization or pregnancy. Those cases include: ovarian insufficiency, developmental anomalies, premature exhaustion of ovarian function and premature menopause. Egg donation is also advisable if it is risk of carrying of hereditary disease from mother to children and sometimes can be offered in cases of repeated unsuccessful IVF cycles.

Usually egg donors are anonymous. It means recipients will have no access to their personal data and will be unable to establish the identity of egg donor. The identity of the recipient will also never be revealed to the egg donor. Although recipients can have some information about donor physical features like height, weight, complexion, blood type and rhesus factor (RF) if needed. When applying for egg donation program recipient fills in the form with preferred physical characteristics of the egg donor and we will do as close match as possible.

It is also possible to come for the procedure with own egg donor. It can be any woman known to recipient below aged below 35 and with no medical contraindications for egg donation.

All our egg donors are tested negative for HIV, Hepatitis B, Hepatitis C, Syphilis, have no family history of hereditary diseases and additional testing for specific diseases can be performed by recipients request. Most donors have at least one child of their own. Donors are 18 – 30 years old. According to international regulation we do not accept person older that 35 to become egg donors.

Egg recipient has to be consulted by the physician and provide a doctor’s written conclusion about the absence of contraindication for pregnancy.

After matching both donor and recipient receive hormonal treatment. For donor its purpose is to stimulate growth of multiple eggs and for recipient it is to prepare uterus to receive the embryos.
Efficiency of IVF cycle with using donor oocytes is relatively high and may reach 50%-60% per cycle.

The treatment is recommended in cases if man either has no spermatozoa of his own or the number and quality of produced spermatozoa are to low to achieve the pregnancy without complex and expensive procedures. Donor sperm can be used in combination with all other assisted reproduction treatments as IUI (intrauterine insemination), IVF or ICSI. Sperm donation is also advisable if it is risk of carrying of hereditary disease from father to children and sometimes can be offered in cases of repeated unsuccessful IVF cycles.

Sperm donors are anonymous. It means recipients will have no access to their personal data and will be unable to establish the identity of sperm donor. The identity of the recipient will also never be revealed to the sperm donor. Although recipients can have some information about donor physical features like height, weight, complexion, blood type and rhesus factor (RF) if needed. When applying for sperm donation program recipient fills in the form with preferred physical characteristics of the sperm donor and we will do as close match as possible. We can also provide the description sheets of all donors available and recipients can make their own choice.

It is also possible to come for the procedure with own sperm donor. It can be any man known to recipient aged below 40 with sperm suitable for intended procedure.

All our sperm donors are repeatedly tested negative for HIV, Hepatitis B, Hepatitis C, Syphilis, have no family history of hereditary diseases and additional testing for specific diseases can be performed by recipients request.

The testing schedule is as follows: donors are tested for HIV, Hepatitis B, Hepatitis C, Syphilis before they are allowed to produce sperm samples for storage. If the test results are negative donors produce several portions of sperm in short period of time and those portions are stored in quarantine tank for minimum of 3 months. After of minimum 3 months since donors produced the last sperm sample they are requested to come for repeated test. Only if repeated tests are negative the sperm samples are allowed to be used for patients.

Donors are 18 – 35 years old. According to international regulation we do not accept person older that 40 to become sperm donors.

Efficiency of  IUI/IVF/ICSI cycle with donor sperm is the same or slightly higher than if husbands sperm is used.

This is a step in the process of assisted reproduction in which embryos are placed into the uterus of the female with the intent to establish a pregnancy.

What is FET?

The initials FET stand for Frozen Embryo Transfer. If you’ve had embryos frozen during a previous cycle, you can return to the Clinic to have some thawed and transferred to your womb.

FET drugs are used to prepare your womb to receive the embryos. We’ll monitor your progress to assess the right time for the transfer, maximising your chances of achieving a pregnancy.

Who needs FET?

FET is appropriate if you have successfully fertilised embryos suitable for freezing, and wish to return for further treatment without going through a full cycle of IVF.

FET is considerably less invasive and less expensive than a fresh IVF cycle, and may be the best choice if you’re considering treatment some time after the embryos were created. For example, you may have chosen to freeze your embryos before receiving cancer treatment, or because of other health factors potentially affecting fertility, or because you wanted to postpone pregnancy for other reasons. Of course, the other reason may be that you have been successful in an earlier cycle(s) and wish to return to add further children to your family.

What happens at the Clinic?

We’ll agree an individualised treatment plan with you and then you’ll attend some monitoring appointments (e.g. ultrasound scans, to decide the optimal timing for your embryo transfer).

Following the thawing of your frozen embryos, one or two can be transferred to your womb through a narrow catheter passed through your cervix. This is the same method that’s used in a fresh IVF cycle.

You’ll be able to take a pregnancy test 18 days after egg collection. If this is positive, you can attend the clinic for a pregnancy scan about 20 days later.

If your embryos are frozen and stored at the Clinic, we’ll contact you each year and ask you to confirm your wishes for the next 12 months. If you wish to continue storage with us there is an annual storage fee.

What is egg donation?

For some women, the gift of donated eggs is their only chance to have a baby. However, there’s an acute shortage of egg donors.

To reduce our waiting list, we run a special programme that allows altruistic women to donate their eggs. If you’re 18-35 and healthy, it may be possible for you to help another woman in this way. You should have no history of mental disorders, and no family history of genetic or inheritable diseases. If you’ve had a hysterectomy or have been sterilised, you could still be a suitable egg donor.

The Human Fertilisation and Embryology Authority (HFEA) allows a payment of £750 to egg donors, to help cover any expenses incurred.

Who benefits from egg donation?

Donated eggs are needed by women who may have:

1. A premature menopause – this affects 1-2% of women under 40
2. Ovaries damaged by chemotherapy or radiotherapy treatment for cancer
3. Been born without functioning ovaries (e.g. Turner’s syndrome)
4. Ovaries resistant to stimulation by the pituitary hormones
5. A high risk of passing on genetic disorders to their offspring
6. Poorly functioning ovaries as they get older

Egg donors often remark that knowing they’ve given a couple the chance to have a family is one of the most rewarding experiences of their lives.

What happens at the Clinic?

We screen all donors to ensure they’re free of infections, diseases or genetic conditions that might be transmitted. We ask them about their medical and family history, and perform a medical examination and blood tests.

One of our consultants will explain the treatment process, potential risks and possible side effects to prospective donors. Before embarking on treatment, prospective donors will also receive implications counselling from an independent counsellor.

The treatment is similar as it is for a woman going through an IVF cycle, although in the case of egg donation, the treatment ends after the collection of the donor’s eggs. The donated eggs are fertilised using the sperm of the recipient’s partner, and the resulting embryos transferred to the recipient’s womb.

What is embryo donation?

Couples who’ve had IVF and completed their families, and who have spare embryos in storage at Bourn Hall Clinic, sometimes decide to donate them to help others suffering infertility. We try to match the characteristics of embryo donors as closely as possible with those of the recipients.

Who needs embryo donation?

Embryo donation is appropriate when both donated eggs and sperm are required for treatment. This may be because egg quality has been compromised, due to previous surgery, cancer treatment, the menopause or genetic disease. In addition, it may be because the man is not producing sperm, or has a severe sperm problem, or because the couple carry an hereditary disease.

What happens at the Clinic?

Both the recipient and the embryo donor are offered counselling before starting treatment or consenting to donation. Our team and the recipient will agree an individualised treatment plan, involving some monitoring appointments that include ultrasound scans. These help us to decide the optimal timing for the donated embryo transfer.

Following the thawing of donated frozen embryos, one or two can be transferred to your womb through a narrow catheter passed through your cervix. This is the same method that would be used in a fresh IVF cycle.

You’ll be able to take a pregnancy test 18 days after egg collection. If this is positive, you can then attend the clinic for a pregnancy scan about 20 days later.

What is embryo freezing?

Embryos are often frozen during an IVF cycle when fresh embryos are transferred and additional embryos created in that cycle, but not transferred at the time, are frozen. However, ‘embryo freezing’ is a specific treatment that involves entering an IVF cycle with the express intention of freezing all the resulting embryos. These can be stored for your future use for up to 10 years.

Who needs embryo freezing?

If you’re a woman, embryo freezing may be an option when you’re facing surgery or cancer therapies that may affect your ability to produce healthy eggs in the future. Of course, there has to be enough time – before these therapies begin – to create the embryos, either with the sperm of your partner or a donor.

Our medical team will liaise closely with your specialist to ensure that the embryo freezing treatment is safe for you, and not detrimental to your medical condition.

If you are a man in similar circumstances, we recommend sperm freezing which is a proven and very successful technique which can be completed more quickly and is much easier for you than undergoing a full IVF cycle.

There may be other circumstances where embryo freezing is also appropriate, and you can discuss these with one of our fertility specialist doctors.

What happens at the Clinic?

Your treatment cycle is exactly the same as it is for IVF. The only difference is that all of your embryos will be frozen at the optimum time – an assessment made by our embryologists – rather than transferred to your womb.

If your embryos are frozen and stored at the Clinic, we’ll contact you each year and ask you to confirm your wishes for the next 12 months. If you wish to continue storage with us there is an annual storage fee.

What is sperm donation?

One in six couples seeks medical help to achieve a pregnancy and, for some, treatment with donated sperm is their only hope of conceiving a baby.

Although sperm donation is established as a form of assisted conception, recent years have seen a fall in the number of donors and there’s a national shortage of sperm for fertility treatment.

To help our patients, Nairobi IVF Center has its own sperm bank and there is no waiting list. While it’s been successful in attracting donations, we still need additional donors if we’re going to help more couples who face difficulties conceiving.

Why is there a need for sperm donation?

There are a number of reasons explaining the need for donated sperm. These include:

1. Cancer treatment, vasectomy, injury, or other male fertility factors resulting in there being no sperm in the partner’s semen
2. An inherited disease, such as haemophilia or Duchenne’s muscular dystrophy, putting the life of a resulting baby at risk
3. Incompatible blood types e.g. if the female partner is Rhesus (Rh) sensitised and the male partner is Rh positive, the pregnancy is potentially problematic
4. Providing treatment for single women or female same-sex couples

Who can donate sperm?

Healthy men aged 18-40 can become sperm donors. You may wish to use a relative or a donor who’s known to you, and this is acceptable if all parties agree to the arrangement.

The Nairobi IVF Center allows a payment of KES 5000 to sperm donors each time they visit the Clinic, to help cover the cost of expenses. Current Kenyan law allows us to create up to 10 families from one sperm donor.

We screen all donors to ensure they’re free of infections, diseases or genetic conditions that might be transmitted. We ask them about their medical and family history, and perform a medical examination and blood tests.

What happens at the Center?

Every donor who attends Nairobi IVF Center has the opportunity to meet one of our consultants, to discuss any aspect of the donation process.

Before you donate, we’ll perform a physical examination, as well as blood and urine tests. As a matter of procedure, we ask all of our male patients to provide a semen sample. The Center has a suite of special rooms designed to put you at ease.

If your semen sample shows that the sperm is of a sufficiently high quality, we’ll ask you to provide 10 to 15 samples over a period of time. These will be prepared and stored for later use.

We rigorously screen all of the sperm samples we collect, and then freeze and quarantine each sample for six months. After this time, we’ll invite you back to the Center to repeat the blood tests.

What is sperm freezing?

Sperm freezing and banking is a form of fertility preservation, intended to keep open your options for having a child in the future.

Sperm can stay frozen for a long period. Under current Kenyan legislation, sperm can be frozen for you for 10 years, or until your 55th birthday whichever comes later.

Who needs sperm freezing?

Impending surgery or treatment that may damage your fertility is the most common reason for freezing and banking sperm. For example vasectomy and treatment for cancer.

If your sperm count or quality is affected by your treatment, or if a vasectomy reversal proves unsuccessful, sperm banking – in conjunction with assisted conception techniques – may allow you to have your own biological child in the future.

What happens at the Center?

You’ll have a consultation with one of our fertility specialists to discuss the procedures involved and to sign the appropriate consent forms. You can also see a counsellor if you wish.

You’ll be required to produce sperm samples and the Center has a suite of special rooms designed to put you at ease. These samples will be frozen for your future use.

If sperm is frozen and stored for you at the Center, we’ll contact you each year and ask you to confirm your wishes for the next 12 months. If you wish to continue storage you will need to pay an annual storage fee, unless your PCT pays for your storage (often the case for cancer patients). In those circumstances, we’ll collect the fee directly from your PCT.

What is SSR?

Surgical Sperm Retrieval (SSR) is a minor surgical procedure that’s used to harvest sperm directly from your testes or epididymi.

Who needs SSR?

The surgical retrieval of sperm may enable the 1-2% of patients who have no sperm in the semen (a condition known as azoospermia) to have successful treatment.

In half of these cases, sperm production is normal but a blockage prevents sperm from entering the semen (obstructive azoospermia). This may be due to:

1. Failure of the sperm passages to develop (congenital absence of the vas deferens)
2. A blockage of the sperm transport tubules (rete, epididymis or vas deferens)
3. A previous vasectomy operation (male sterilisation)

For the other half, there’s insufficient sperm production and this can be due to:

1. A congenital problem
2. A previous disease
3. X-ray treatment

What happens at the Center?

You’ll have a consultation with our Gynaecologist. The Consultant will examine you and organise any appropriate tests, such as hormone analysis, chromosome analyses (in particular looking at the Y chromosome), and virology screening. You’ll agree a treatment programme together and decide when you’d like to have your SSR operation.

Depending on the reason for a lack of sperm in your semen, the Consultant will suggest the most appropriate form of retrieval in your case. We can perform several different procedures (PESA or TESA), which involve either local or general anaesthetic. In all cases, you’ll be able to go home the same day, although having a general anaesthetic will mean you’re unable to drive yourself home after the operation.

Usually, we’ll perform the SSR before the IVF cycle. The suitable sperm that we retrieve will be frozen and stored for use in future IVF treatment cycles. We always use SSR in conjunction with ICSI during the IVF cycle, as this gives us a better chance of achieving fertilisation.

If sperm is frozen and stored for you at the IVF Center, we’ll contact you each year and ask you to confirm your wishes for the next 12 months. If you wish to continue storage with us there is an annual storage fee.

What is PESA?

PESA stands for Percutaneous Epididymal Sperm Aspiration. This is where a fine needle is inserted into the epididymus, above the testis, and sperm may be obtained by gentle suction.

Who needs PESA?

This procedure is usually appropriate if you do not have any sperm within the ejaculate, due to a blockage of some kind. This may be because of earlier surgery, such as a vasectomy.

What happens at the Clinic?

You’ll have a consultation with one of our Consultant Urologists who specialises in fertility. The Consultant will examine you and organise any appropriate tests, such as hormone analysis, chromosome analyses (in particular looking at the Y chromosome), and virology screening. You’ll agree a treatment programme together and decide when you’d like to have your SSR operation.

All surgical sperm retrieval cases – including PESA – involve day surgery, so you’ll be able to go home on the same day as your operation. Usually, we’ll perform the SSR before the IVF cycle, and the suitable sperm retrieved will be frozen and stored for use in future IVF treatment cycles.

We always use PESA in conjunction with ICSI during the IVF cycle, as this gives us a better chance of achieving fertilisation.

If sperm is frozen and stored for you at the Clinic, we’ll contact you each year and ask you to confirm your wishes for the next 12 months. If you wish to continue storage with us there is an annual storage fee.

What is TESA?

Testicular Sperm Aspiration (TESA) occurs when a fine needle is inserted into the testis and samples of tissue containing sperm are obtained by gentle suction.

Who needs TESA?

These procedures are usually appropriate if you have no sperm within the ejaculate, due to defective sperm production. This may be because of previous testicular surgery, previous medical treatment, or a genetic problem.

What happens at the Center?

You’ll have a consultation with our Gynaecologist. The Consultant will examine you and organise any appropriate tests, such as hormone analysis, chromosome analyses (in particular looking at the Y chromosome), and virology screening. You’ll agree a treatment programme together and decide when you’d like to have your SSR operation.

All surgical sperm retrieval cases – including TESA  – involve day surgery, so you’ll be able to go home on the same day as your operation. Usually, we’ll perform TESA before the IVF cycle, and the suitable sperm retrieved will be frozen and stored for use in future IVF treatment cycles.

We always use TESA in conjunction with ICSI during the IVF cycle, as this gives us a better chance of achieving fertilisation.

If sperm is frozen and stored for you at the Clinic, we’ll contact you each year and ask you to confirm your wishes for the next 12 months. If you wish to continue storage with us there is an annual storage fee.

What is intralipid?

Intralipid is a 20% fat emulsion that is administered routinely by the intravenous route, as a source of fat and energy, typically to patients who are unable to eat for prolonged periods of time.  The main constituents are soya oil and egg yolk, with trace amounts of peanut oil.  If you are allergic to any of these ingredients, then you should not use intralipid.

Why is intralipid used in IVF?

It has been known for some years that intralipid causes mild suppression of the immune system.  Recently reproductive immunologists have started using intralipid in IVF to treat women who suffer from recurrent miscarriage, or repeated failed implantation following embryo transfer.  An embryo contains only half the genetic material of the mother, therefore her womb (uterus) may see it as an invader, like a germ or foreign body.  Normally the lining of the uterus contains immune cells that are specially adapted to tolerate an embryo.  However, when these “friendly” cells are not there or do not work as they should, then the mother’s immune system may attack or reject the embryo with so-called “natural killer” or NK cells.  This would make it difficult or impossible for the embryo to implant in the lining of the uterus.  It is thought that intralipid is able to change the immune cells in the uterine lining, making the environment in the uterus more friendly towards the embryo.

Who may benefit from intralipid?

Unfortunately there are no reliable tests available today that can confirm or exclude with 100% certainty whether a woman’s immune system will reject any embryo that tries to implant in her uterus.  Usually an immune problem is suspected in women who suffer from recurrent miscarriages or repeated failed IVF attempts, in spite of having good quality embryos, when no other cause has been found.  In view of its excellent safety profile,  we are happy to offer intralipid to any woman who may benefit from it, after detailed discussions with one of our consultants.  Currently there is  only a limited amount of evidence available about the efficacy of intralipid in IVF, however there have been encouraging reports in the UK and elsewhere.  In our experience, after treating over 100 women of different ages with intralipid, we have observed a success rate of 39%.  This brings the success rate of these women, with a history of several failed treatments, in line with the average rate of success seen in the general IVF population.

What happens at the Center?

Intralipid is administered at the clinic by intravenous drip infusion, over a period of 1-2 hours.  You would need an infusion every 3-4 weeks for a total of 4-5 infusions.  The first infusion is administered a few days before the embryo transfer, the second after a positive pregnancy test, the third after a viable pregnancy has been confirmed by ultrasound scan at 6-7 weeks of gestation, and the last infusion 3-4 weeks later.  After that it is thought that the embryo should be well enough established to develop further safely without further intralipid support.

Preimplantation genetic diagnosis (PGD) is a procedure used prior to implantation to help identify genetic defects within embryos created through in vitro fertilization to prevent certain diseases or disorders from being passed on to the child.

How Is The PGD Performed?

Preimplantation genetic diagnosis begins with the normal process of in vitro fertilization that includes egg retrieval and fertilization in a laboratory. Over the next three days the embryo will divide into eight cells. Preimplantation genetic diagnosis involves the following steps:

1. First, one or two cells are removed from the embryo.
2. The cells are then evaluated to determine if the inheritance of a problematic gene is present in the embryo.
3. Once the PGD procedure has been performed and embryos free of genetic problems have been identified, the embryo will  be placed back in the uterus, and implantation will be attempted.
4. Any additional embryos that are free of genetic problems may be frozen for later use while embryos with the problematic gene are destroyed.

Who Can Benefit From PGD?

Preimplantation genetic diagnosis can benefit any couple at risk for passing on a genetic disease or condition. The following is a list of the type of individuals who are possible candidates for PGD:

1. Carriers of sex-linked genetic disorders
2. Carriers of single gene disorders
3. Those with chromosomal disorders
4. Women age 35 and over
5. Women experiencing recurring pregnancy loss
6. Women will more than one failed fertility treatment

PGD can also be used for the purpose of gender selection.

What Are The Benefits Of PGD?

The following are considered benefits of PGD:

• PGD can test for more than 100 different genetic conditions.
• The procedure is performed before implantation thus allowing the couple to decide if they wish to continue with the pregnancy.
• The procedure enables couples to pursue biological children who might not have done so otherwise.

What is pre-implantation genetic screening (PGS)?

PGS (also known as aneuploidy screening) involves checking the chromosomes of embryos conceived by IVF or ICSI for common abnormalities. Chromosomal abnormalities are a major cause of the failure of embryos to implant, and of miscarriages. They can also cause conditions such as Down’s syndrome…

Is PGS for me?

Your specialist may recommend PGS if:

• you are over 35 and have a higher risk of having a baby with a chromosome problem (such as Down’s syndrome)
• you have a family history of chromosome problems
• you have a history of recurrent miscarriages
• you have had several unsuccessful cycles of IVF where embryos have been transferred, or
• your sperm are known to be at high risk of having chromosome problems.

How does PGS work?

The procedure for PGS is usually as follows:

Step 1.  You undergo normal IVF or ICSI treatment to collect and fertilise your eggs

Step 2. The embryo is grown in the laboratory for two to three days until the cells have divided and the embryo consists of about eight cells.

Step 3. A trained embryologist removes one or two of the cells (blastomeres) from the embryo.

Step 4. The chromosomes are examined to see how many there are and whether they are normal.

Step 5. One, two or three of the embryos without abnormal numbers of chromosomes are transferred to the womb so that they can develop. Any remaining unaffected embryos can be frozen for later use.

Step 6. Those embryos that had abnormal chromosomes are allowed to perish or may be used for research (with your consent).

Possible variations to this procedure

There are possible variations to this procedure and the trophectoderm biopsy technique can be used in some cases.

Testing at five to six days
It is possible that instead of removing and testing one or two cells from a two – three day old embryo, some centres may allow the embryo to develop to five – six days, when there are 100-150 cells.

More cells can be removed at this stage without compromising the viability of the embryo, possibly leading to a more accurate test.

Alternatively some centres may test eggs for chromosomal abnormalities before they are used to create embryos. Polar bodies (small cells extruded by eggs as they mature) can be extracted and tested.

Comparative Genomic Hybridisation (CGH)
A small number of clinics are now using a procedure called comparative genomic hybridisation (CGH) which allows centres to test for abnormalities in all 23 chromosomes.

These abnormalities may or may not be of biological significance, but their presence will lower the chance of finding suitable embryos for transfer.

Personal genetic analysis is based on an overview of your DNA. It gives appropriate recommendations in the field of early prevention and appropriate action, to reduce the risk of developing a disease. This is especially important for those of us who are more exposed because of our genetic makeup.

The main goals of the genetic analysis are:

• To provide information for enabling appropriate action and lifestyle changes.
• To reduce the risk or prevent the development of certain diseases.
• To draw attention to genetic predisposition for certain diseases, so that early detection through screening and timely treatment would be possible.
• To adjust the dosage of medications according to our DNA and so increase the safety and efficacy of the therapy.
• To provide information about the hidden characteristics of the body, so that we could understand our body better, learn to know it and act accordingly.

Personal genetic analysis will:

• Reveal what is written in your genes
• Help to understand how genes influence your life
• Advice, how you can take advantage from your genetic makeup

Personal genetic analysis includes analyses of many modern diseases. It consists of three thematic sections, in which you will:

• Get familiar with genetic predispositions to develop cardiovascular diseases, cancers and other diseases
• Learn about your response to medicaments
• Receive insight into genetically determined physical characteristics and abilities

Analysis results are easy to understand and consist plenty of useful information

Your individual analysis report will lead you in a clear and intuitive way from general information through personal results to health advice and possible preventive measures. Consequently it allows you to reduce the risk of developing a disease or helps the disease to be detected early on for timely treatment.

Accordance with current guidelines

Personal genetic analysis is designed in accordance with current rules and guidelines for genetic analysis. It follows the recommendations and provisions of the British Human Genetics Commission, intended for the general populous.

Carefully designed DNA analysis

Great importance is given to the appropriate choice of genetic markers. Because of the extremely high number of genetic markers, we include in the analysis only those, which prove reliable and, for which a scientific research has been performed on highest quality. We try to include studies that have results independently verified in other studies and that have high statistical reliability by having been performed on a sample set of at least 1000 people. We mostly choose studies which have been published in highly recognized scientific magazines.

Expert opinion and preventive advice

Special attention is given to the appropriate compilation of professional advice and preventive measures. Specialized experts in the field of medicine and pharmacy take care of this by giving appropriate guidelines based on genetic information.